HR 2244 IHCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care coordination services, and for other purposes.CommentsClose CommentsPermalink

May 9, 2007

Mr. GENE GREEN of Texas introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care coordination services, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the `Geriatric Assessment and Chronic Care Coordination Act of 2007'.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Findings.CommentsClose CommentsPermalink





Sec. 3. Medicare coverage of geriatric assessments.CommentsClose CommentsPermalink





Sec. 4. Medicare coverage of chronic care coordination services.CommentsClose CommentsPermalink





Sec. 5. Outreach activities regarding geriatric assessments and chronic care coordination services under the Medicare program.CommentsClose CommentsPermalink





Sec. 6. Study and report on geriatric assessments and chronic care coordination services under the Medicare program.CommentsClose CommentsPermalink





Sec. 7. Study and report on best practices for Medicare chronic care coordination.CommentsClose CommentsPermalink





Sec. 8. Rule of construction.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

Congress makes the following findings:CommentsClose CommentsPermalink





(1) The Medicare program must be redesigned to provide high-quality, cost-effective care to the growing population of elderly individuals with multiple chronic conditions.CommentsClose CommentsPermalink





(2) According to the Congressional Budget Office, approximately 43 percent of Medicare costs can be attributed to 5 percent of Medicare's most costly beneficiaries.CommentsClose CommentsPermalink





(3) Currently, 78 percent of the Medicare population has at least 1 chronic condition, and 2/3 have more than 1 chronic condition. The 20 percent of beneficiaries with 5 or more chronic conditions account for 2/3 of all Medicare spending. In addition, the large baby boomer generation is moving toward retirement and Medicare eligibility.CommentsClose CommentsPermalink





(4) The prevalence of chronic conditions increases with age: 74 percent of the 65- to 69-year-old group has at least 1 chronic condition, while 86 percent of the 85 years and older group has at least 1 chronic condition. Similarly, just 14 percent of the 65- to 69-year-old group has 5 or more chronic conditions, while 28 percent of the 85 years and older group has 5 or more chronic conditions.CommentsClose CommentsPermalink





(5) There is a strong pattern of increasing utilization as the number of conditions increase. Fifty-five percent of Medicare beneficiaries with 5 or more conditions experienced an inpatient hospital stay compared to 5 percent of those with 1 condition or 9 percent of those with 2 conditions.CommentsClose CommentsPermalink





(6) In terms of physician visits, the average Medicare beneficiary has over 15 physician visits annually and sees 6 different physicians annually.CommentsClose CommentsPermalink





(7) When Alzheimer's disease or other form of dementia are present along with 1 or more other chronic conditions, utilization also increases. For example, in 2000, total average per person Medicare expenditures for those with congestive heart failure and Alzheimer's or dementia were 47 percent higher than for those with congestive heart failure and no dementia.CommentsClose CommentsPermalink





(8) Research conducted in the United States and internationally indicate that the delivery of higher quality health care, increased efficiency, and cost-effectiveness are the result of systems in which patients are linked with a physician or another qualified health professional who coordinates their care.CommentsClose CommentsPermalink





(9) The current Medicare program does not reward physicians for integrating and coordinating health care because these services are not explicitly recognized and distinctly paid for. Instead, physicians are incentivized to provide episodic care and to generate more individual patient visits to the doctor's office and hospital for separately reimbursed tests and procedures.CommentsClose CommentsPermalink





(10) The chronic care model established by this Act includes several elements that are effective in managing chronic disease, including--CommentsClose CommentsPermalink





(A) linkages with community resources;CommentsClose CommentsPermalink





(B) health care system changes that reward quality chronic care;CommentsClose CommentsPermalink





(C) support for patient self-management of chronic disease;CommentsClose CommentsPermalink





(D) practice redesign;CommentsClose CommentsPermalink





(E) evidence-based clinical practice guidelines; andCommentsClose CommentsPermalink





(F) clinical information systems, such as electronic medical records and continuity of care records.CommentsClose CommentsPermalink





(11) Financial incentives within the Medicare program should be realigned as part of a comprehensive system change. The Medicare program should be restructured to reimburse physicians and other qualified health professionals for the cost of coordinating care.CommentsClose CommentsPermalink





(12) The provisions of, and amendments made by, this Act are intended to--CommentsClose CommentsPermalink





(A) create savings to the Medicare program;CommentsClose CommentsPermalink





(B) establish a process to identify those Medicare beneficiaries most likely to benefit from having a provider coordinate their health care needs; andCommentsClose CommentsPermalink





(C) establish a payment under the Medicare program for--CommentsClose CommentsPermalink





(i) the assessment of those health care needs; andCommentsClose CommentsPermalink





(ii) the activities required to coordinate those health care needs.CommentsClose CommentsPermalink

SEC. 3. MEDICARE COVERAGE OF GERIATRIC ASSESSMENTS.

(a) Coverage of Geriatric Assessments-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (Z), by striking `and' at the end;CommentsClose CommentsPermalink





(B) in subparagraph (AA), by adding `and' at the end; andCommentsClose CommentsPermalink





(C) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(BB) geriatric assessments (as defined in subsection (ccc)(1));'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS- (A) Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking `or (K)' and inserting `(K), or (BB)'.CommentsClose CommentsPermalink





(B) Clauses (i) and (ii) of section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)) are each amended by striking `subsection (ww)(1)' and inserting `subsections (ww)(1) and (ccc)(1)'.CommentsClose CommentsPermalink





(b) Geriatric Assessments Defined- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsections:CommentsClose CommentsPermalink

`Geriatric Assessment

`(ccc)(1) The term `geriatric assessment' means each of the following:CommentsClose CommentsPermalink





`(A) An assessment of the clinical status, functional status, social and environmental functioning, and need for caregiving of a geriatric assessment eligible individual (as defined in subsection (ddd)). The assessment shall include a comprehensive history and physical examination and assessments of the following domains using standardized validated clinical tools:CommentsClose CommentsPermalink





`(i) Comprehensive review of medications and the individual's adherence to the medication regimen.CommentsClose CommentsPermalink





`(ii) Measurement of affect, cognition and executive function, mobility, balance, gait, risk of falling, and sensory function.CommentsClose CommentsPermalink





`(iii) Social functioning, environmental needs, and caregiver resources and needs.CommentsClose CommentsPermalink





`(iv) Any other domain determined appropriate by the Secretary.CommentsClose CommentsPermalink





`(B) Subsequent assessments, which may not be conducted more frequently than annually, unless the subsequent assessment is medically necessary due to a significant change in the condition of the geriatric assessment eligible individual.CommentsClose CommentsPermalink





`(C) The development of a written care plan based on the results of the assessment under subparagraph (A) (and any subsequent assessment under subparagraph (B)). The care plan shall detail identified problems, outline therapies, assign responsibility for actions, and indicate whether the individual is likely to benefit from chronic care coordination services (as defined in subsection (eee)(1)). If the individual is determined likely to benefit from chronic care coordination services, the care plan shall also provide the basis for the chronic care coordination plan to be developed by the chronic care manager pursuant to subsection (eee).CommentsClose CommentsPermalink





`(2) A geriatric assessment may only be conducted by--CommentsClose CommentsPermalink





`(A) a physician;CommentsClose CommentsPermalink





`(B) a practitioner described in section 1842(b)(18)(C)(i) under the supervision of a physician; orCommentsClose CommentsPermalink





`(C) any other provider that meets such conditions as the Secretary may specify.CommentsClose CommentsPermalink

`Geriatric Assessment Eligible Individual

`(ddd)(1) Subject to paragraph (3), the term `geriatric assessment eligible individual' means an individual identified by the Secretary as eligible for a geriatric assessment.CommentsClose CommentsPermalink





`(2) In identifying individuals under paragraph (1), the following rules shall apply:CommentsClose CommentsPermalink





`(A) The individual must have at least 1 of the following present:CommentsClose CommentsPermalink





`(i) Multiple chronic conditions.CommentsClose CommentsPermalink





`(ii) Dementia, as defined in the most recent Diagnostic and Statistical Manual of Mental Disorders, and at least 1 chronic condition.CommentsClose CommentsPermalink





`(iii) Any other factor identified by the Secretary.CommentsClose CommentsPermalink





`(B)(i) The individual, as determined by the Secretary--CommentsClose CommentsPermalink





`(I) must have aggregate medical costs under this title in the top 10 percent of all applicable individuals during the previous 36 months; orCommentsClose CommentsPermalink





`(II) is likely to incur costs under this title in the top 10 percent of all applicable individuals during the current or subsequent calendar year.CommentsClose CommentsPermalink





`(ii) The determination under clause (i)(II) of future costs shall be based on the medical condition of the individual, the individual's past cost to the program under this title, and other factors as identified by the Secretary.CommentsClose CommentsPermalink





`(iii) The individual meets such additional criteria (if any) as the Secretary establishes under subparagraph (C).CommentsClose CommentsPermalink





`(C)(i) If the Secretary estimates that the total number of applicable individuals that would be geriatric assessment eligible individuals in a year (but for this subparagraph) exceeds 10 percent of the total number of applicable individuals in the year, the Secretary shall establish and apply under subparagraph (B)(iii) such additional criteria as is designed to eliminate such excess.CommentsClose CommentsPermalink





`(ii) The Secretary shall consult with physicians, physician groups, organizations representing individuals with chronic conditions and older adults, and other stakeholders in identifying any additional criteria under clause (i).CommentsClose CommentsPermalink





`(D) For purposes of this paragraph, the term `applicable individual' means an individual enrolled for benefits under part B but not enrolled in a Medicare Advantage plan or a plan under section 1876.CommentsClose CommentsPermalink





`(3) The term `geriatric assessment eligible individual' shall not include the following individuals:CommentsClose CommentsPermalink





`(A) An individual who is receiving hospice care under this title.CommentsClose CommentsPermalink





`(B) An individual who is residing in a skilled nursing facility, a nursing facility (as defined in section 1919), or any other facility identified by the Secretary.CommentsClose CommentsPermalink





`(C) An individual medically determined to have end-stage renal disease.CommentsClose CommentsPermalink





`(D) An individual enrolled in a Medicare Advantage plan or a plan under section 1876.CommentsClose CommentsPermalink





`(E) An individual enrolled in a PACE program under section 1894.CommentsClose CommentsPermalink





`(F) Any other categories of individuals determined appropriate by the Secretary.CommentsClose CommentsPermalink





`(4) For purposes of this subsection, the term `chronic condition' means a condition, such as dementia, that lasts or is expected to last 1 year or longer, limits what an individual can do, and requires ongoing care.'.CommentsClose CommentsPermalink





(c) Payment and Elimination of Cost-Sharing-CommentsClose CommentsPermalink





(1) PAYMENT AND ELIMINATION OF COINSURANCE- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (N), by inserting `other than geriatric assessments (as defined in section 1861(ccc)(1))' after `(as defined in section 1848(j)(3))';CommentsClose CommentsPermalink





(B) by striking `and' before `(V)'; andCommentsClose CommentsPermalink





(C) by inserting before the semicolon at the end the following: `, and (W) with respect to geriatric assessments (as defined in section 1861(ccc)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848'.CommentsClose CommentsPermalink





(2) PAYMENT UNDER PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(BB),' after `(2)(AA),'.CommentsClose CommentsPermalink





(3) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-CommentsClose CommentsPermalink





(A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by striking `and diagnostic mammography' and inserting `, diagnostic mammography, or geriatric assessments (as defined in section 1861(ccc)(1))'.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended--CommentsClose CommentsPermalink





(i) in subparagraph (F), by striking `and' at the end;CommentsClose CommentsPermalink





(ii) in subparagraph (G)(ii), by striking the comma at the end and inserting `; and'; andCommentsClose CommentsPermalink





(iii) by inserting after subparagraph (G)(ii) the following new subparagraph:CommentsClose CommentsPermalink





`(H) with respect to geriatric assessments (as defined in section 1861(ccc)(1)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(W),'.CommentsClose CommentsPermalink





(4) ELIMINATION OF DEDUCTIBLE- The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended--CommentsClose CommentsPermalink





(A) by striking `and' before `(8)'; andCommentsClose CommentsPermalink





(B) by inserting before the period the following: `, and (9) such deductible shall not apply with respect to geriatric assessments (as defined in section 1861(ccc)(1))'.CommentsClose CommentsPermalink





(d) Frequency Limitation- Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--CommentsClose CommentsPermalink





(1) by striking `and' at the end of subparagraph (M);CommentsClose CommentsPermalink





(2) by striking the semicolon at the end of subparagraph (N) and inserting `, and'; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(O) in the case of geriatric assessments (as defined in section 1861(ccc)(1)), which are performed more frequently than is covered under such section;'.CommentsClose CommentsPermalink





(e) Exception to Limits on Physician Referrals- Section 1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(6) GERIATRIC ASSESSMENTS- In the case of a designated health service, if the designated health service is a geriatric assessment (as defined in section 1861(ccc)(1)) and furnished by a physician.'.CommentsClose CommentsPermalink





(f) Rulemaking- The Secretary of Health and Human Services shall define such terms, establish such procedures, and promulgate such regulations as the Secretary determines necessary to implement the amendments made by, and the provisions of, this section, including the establishment of additional domains under subsection (ccc)(1)(A)(iv) of section 1861 of the Social Security Act, as added by subsection (b). In promulgating such regulations, the Secretary shall consult with physicians, physician groups and organizations, and organizations representing individuals with chronic conditions and older adults.CommentsClose CommentsPermalink





(g) Effective Date- The amendments made by this section shall apply to assessments furnished on or after January 1, 2008.CommentsClose CommentsPermalink

SEC. 4. MEDICARE COVERAGE OF CHRONIC CARE COORDINATION SERVICES.

(a) Part B Coverage of Chronic Care Coordination Services-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 3(a)(1), is amended--CommentsClose CommentsPermalink





(A) in subparagraph (AA), by striking `and' at the end;CommentsClose CommentsPermalink





(B) in subparagraph (BB), by adding `and' at the end; andCommentsClose CommentsPermalink





(C) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(CC) chronic care coordination services (as defined in subsection (eee));'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)), as amended by section 3(a)(2)(A), is amended by striking `or (BB)' and inserting `(BB), or (CC)'.CommentsClose CommentsPermalink





(B) Clauses (i) and (ii) of section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)), as amended by section 3(a)(2)(B), are each amended by striking `subsections (ww)(1) and (ccc)' and inserting `subsections (ww)(1), (ccc), and (eee)'.CommentsClose CommentsPermalink





(b) Services Described- Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 3(b), is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink

`Chronic Care Coordination Services; Chronic Care Manager; Chronic Care Eligible Individual

`(eee)(1) The term `chronic care coordination services' means services that are furnished to a chronic care eligible individual (as defined in paragraph (3)) by a single chronic care manager (as defined in paragraph (2)) chosen by the individual under a plan of care prescribed by such chronic care manager for the purpose of chronic care and dementia coordination, which may include any of the following services:CommentsClose CommentsPermalink





`(A) The development of an initial plan of care (based on the results of a geriatric assessment, as defined in subsection ccc)), and subsequent appropriate revisions to that plan of care.CommentsClose CommentsPermalink





`(B) The management of, and referral for, medical and other health services, including interdisciplinary care conferences and management with other providers.CommentsClose CommentsPermalink





`(C) The monitoring and management of medications.CommentsClose CommentsPermalink





`(D) Patient education and counseling services.CommentsClose CommentsPermalink





`(E) Family caregiver education and counseling services.CommentsClose CommentsPermalink





`(F) Self-management services, including health education and risk appraisal to identify behavioral risk factors through self-assessment.CommentsClose CommentsPermalink





`(G) Providing access by telephone with physicians and other appropriate health care professionals, including 24-hour availability of such professionals for emergencies.CommentsClose CommentsPermalink





`(H) Management with the principal nonprofessional caregiver in the home.CommentsClose CommentsPermalink





`(I) Managing and facilitating transitions among health care professionals and across settings of care, including the following:CommentsClose CommentsPermalink





`(i) Pursuing the treatment option elected by the individual.CommentsClose CommentsPermalink





`(ii) Including any advance directive executed by the individual in the medical file of the individual.CommentsClose CommentsPermalink





`(J) Information about, and referral to, hospice care, including patient and family caregiver education and counseling about hospice care, and facilitating transition to hospice care when elected.CommentsClose CommentsPermalink





`(K) Information about, referral to, and management with, community services.CommentsClose CommentsPermalink





`(L) Such additional services for which payment would not otherwise be made under this title that the Secretary may specify that encourage the receipt of, or improve the effectiveness of, the services described in the preceding subparagraphs.CommentsClose CommentsPermalink





`(2)(A) For purposes of this subsection, the term `chronic care manager' means an individual or entity that--CommentsClose CommentsPermalink





`(i) is--CommentsClose CommentsPermalink





`(I) a physician;CommentsClose CommentsPermalink





`(II) a practitioner described in clause (i) or (iv) of section 1842(b)(18)(C) under the supervision of a physician; orCommentsClose CommentsPermalink





`(III) any other provider that meets such conditions as the Secretary may specify; andCommentsClose CommentsPermalink





`(ii) has entered into a chronic care coordination agreement with the Secretary.CommentsClose CommentsPermalink





`(B)(i) For purposes of subparagraph (A)(ii), each chronic care coordination agreement shall meet the requirements described in subparagraph (C) and shall--CommentsClose CommentsPermalink





`(I) subject to clause (ii), be entered into for a period of 3 years and may be renewed if the Secretary is satisfied that the chronic care manager continues to meet such terms and conditions as the Secretary may require; andCommentsClose CommentsPermalink





`(II) contain such other terms and conditions as the Secretary may require.CommentsClose CommentsPermalink





`(ii) Each chronic care coordination agreement shall provide for the termination of such agreement prior to such 3-year period in the case where the chronic care manager--CommentsClose CommentsPermalink





`(I) is no longer able to provide chronic care services; orCommentsClose CommentsPermalink





`(II) does not meet such terms and conditions as the Secretary may require.CommentsClose CommentsPermalink





`(C)(i) Subject to clause (ii), the requirements of this subparagraph are met if the agreement requires the chronic care manager to perform, or provide for the performance of, the following services:CommentsClose CommentsPermalink





`(I) Advocating for, and providing ongoing support, oversight, and guidance with respect to the implementation of a plan of care that provides an integrated, coherent, and cross-disciplined plan for ongoing medical care that is developed in partnership with the chronic care eligible individual and all other physicians and other care providers and agencies (including home health agencies) providing care to the chronic care eligible individual.CommentsClose CommentsPermalink





`(II) Using evidence-based medicine and clinical decision support tools to guide decision making at the point of care and on the basis of specific patient factors.CommentsClose CommentsPermalink





`(III) Using health information technology, including, where appropriate, remote monitoring and patient registries, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services.CommentsClose CommentsPermalink





`(IV) Encouraging patients to engage in the management of their own health through education and support systems.CommentsClose CommentsPermalink





`(V) Incorporating family caregivers into the chronic care planning process.CommentsClose CommentsPermalink





`(ii) The Secretary may modify the services required under the agreement under clause (i), including by requiring different services or services in addition to those described in subclauses (I) through (V) of such clause.CommentsClose CommentsPermalink





`(D) The Secretary shall adopt procedures which exempt providers in rural areas from providing 1 or more of the services otherwise required to be provided under subparagraph (C) or modify such requirements for such providers. In establishing such procedures, the Secretary shall ensure that such exemptions and modifications do not impact the quality of chronic care coordination services furnished by such providers.CommentsClose CommentsPermalink





`(3) For purposes of this subsection, the term `chronic care eligible individual' means a geriatric assessment eligible individual (as defined in subsection (ddd)) who has undergone a geriatric assessment (as defined in subsection (ccc)(1)) which determined that the individual would benefit from chronic care coordination.'.CommentsClose CommentsPermalink





(c) Payment and Elimination of Cost-Sharing-CommentsClose CommentsPermalink





(1) PAYMENT AND ELIMINATION OF COINSURANCE- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 3(c)(1), is amended--CommentsClose CommentsPermalink





(A) in subparagraph (N), by inserting `or chronic care coordination services (as defined in section 1861(eee))' after `other than geriatric assessments (as defined in section 1861(ccc)(1))';CommentsClose CommentsPermalink





(B) by striking `and' before `(W)'; andCommentsClose CommentsPermalink





(C) by inserting before the semicolon at the end the following: `, and (X) with respect to chronic care coordination services (as defined in section 1861(eee)), the amount paid shall be 100 percent of the amount determined under section 1848(m)'.CommentsClose CommentsPermalink





(2) PAYMENT-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(m) Payment for Chronic Care Coordination Services-CommentsClose CommentsPermalink





`(1) ESTABLISHMENT-CommentsClose CommentsPermalink





`(A) IN GENERAL- The Secretary shall establish a monthly care coordination payment amount under this section for chronic care coordination services (as defined in paragraph (1) of section 1861(eee)(1)) furnished to a chronic care eligible individual (as defined in paragraph (3) of such section) by a chronic care manager (as defined in paragraph (2) of such section 1861).CommentsClose CommentsPermalink





`(B) REQUIREMENTS- In establishing payment amounts under subparagraph (A), the Secretary shall--CommentsClose CommentsPermalink





`(i) take into account the time required of the chronic care manager in providing the care coordination services to chronic care eligible individuals and the costs associated with the practice-level health information technologies and systems incurred by the chronic care manager in providing such services; andCommentsClose CommentsPermalink





`(ii) ensure that such payments do not result in a reduction in payments for office visits or other evaluation and management services that would otherwise be allowable.CommentsClose CommentsPermalink





`(2) CODE- Under the conditions set forth in this section, the Secretary shall develop a care coordination payment code for chronic care coordination services and a value for such code.CommentsClose CommentsPermalink





`(3) SEPARATE PAYMENTS FROM PAYMENTS FOR GERIATRIC ASSESSMENTS- Payments for chronic care coordination services shall be made separately from payments for geriatric assessments (as defined in section 1861(ccc)(1)) and other services for which payment is made under this title.'.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENT- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as amended by section 3(c)(2)), is amended by inserting `(2)(CC),' after `(2)(BB),'.CommentsClose CommentsPermalink





(3) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-CommentsClose CommentsPermalink





(A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as amended by section 3(c)(3)(A), is amended by striking `or geriatric assessments (as defined in section 1861(ccc)(1))' and inserting `geriatric assessments (as defined in section 1861(ccc)(1)), or chronic care coordination services (as defined in section 1861(eee)(1))'.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)), as amended by section 3(c)(3)(B), is amended--CommentsClose CommentsPermalink





(i) in subparagraph (G)(ii), by striking `and' at the end;CommentsClose CommentsPermalink





(ii) in subparagraph (H), by striking the comma at the end and inserting `; and'; andCommentsClose CommentsPermalink





(iii) by inserting after subparagraph (H) the following new subparagraph:CommentsClose CommentsPermalink





`(I) with respect to chronic care coordination services (as defined in section 1861(eee)(1)) furnished by an outpatient department of a hospital, the amount determined under section 1848(m),'.CommentsClose CommentsPermalink





(4) ELIMINATION OF DEDUCTIBLE- Paragraph (9) of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as added by section 3(c)(4), is amended by inserting `or chronic care coordination services (as defined in section 1861(eee)(1))' after `geriatric assessments (as defined in section 1861(ccc)(1))'.CommentsClose CommentsPermalink





(d) Application of Limits on Billing- Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:CommentsClose CommentsPermalink





`(vii) A chronic care manager (as defined in section 1861(eee)(2)) that is not a physician.'.CommentsClose CommentsPermalink





(e) Exception to Limits on Physician Referrals- Section 1877(b)(6) of the Social Security Act (42 U.S.C. 1395nn(b)(6)), as amended by section 3(e), is amended to read as follows:CommentsClose CommentsPermalink





`(6) GERIATRIC ASSESSMENTS AND CHRONIC CARE COORDINATION SERVICES- In the case of a designated health service, if the designated health service is--CommentsClose CommentsPermalink





`(A) a geriatric assessment or a chronic care coordination service (as defined in subsections (ccc)(1) or (eee)(1) of section 1861, respectively); andCommentsClose CommentsPermalink





`(B) provided by a physician or a chronic care manager (as defined in section 1861(eee)(2)).'.CommentsClose CommentsPermalink





(f) Rulemaking- The Secretary of Health and Human Services shall define such terms, establish such procedures, and promulgate such regulations as the Secretary determines necessary to implement the amendments made by, and the provisions of, this section. In promulgating such regulations, the Secretary shall consult with physicians, physician groups and organizations, and organizations representing individuals with chronic conditions and older adults.CommentsClose CommentsPermalink





(g) Effective Date- The amendments made by this section shall apply to chronic care coordination services furnished on or after January 1, 2008.CommentsClose CommentsPermalink

SEC. 5. OUTREACH ACTIVITIES REGARDING GERIATRIC ASSESSMENTS AND CHRONIC CARE COORDINATION SERVICES UNDER THE MEDICARE PROGRAM.

The Secretary of Health and Human Services shall conduct outreach activities to individuals likely to be eligible to receive coverage of geriatric assessments (as defined in subsection (ccc) of section 1861 of the Social Security Act, as added by section 3) under the Medicare program and individuals likely to be eligible to receive coverage of chronic care coordination services (as defined in subsection (eee) of such section 1861, as added by section 4) under the Medicare program, to inform such individuals about the availability of such benefits under the Medicare program.CommentsClose CommentsPermalink

SEC. 6. STUDY AND REPORT ON GERIATRIC ASSESSMENTS AND CHRONIC CARE COORDINATION SERVICES UNDER THE MEDICARE PROGRAM.

(a) Study- The Secretary of Health and Human Services shall enter into a contract with an entity to conduct a study on--CommentsClose CommentsPermalink





(1) the effectiveness of the coverage of geriatric assessments and chronic care coordination services under the Medicare program (under the amendments made by sections 3 and 4) on improving the quality of care provided to Medicare beneficiaries with chronic conditions, including dementia; andCommentsClose CommentsPermalink





(2) the impact of such geriatric assessments and care coordination services on reducing expenditures under title XVIII of the Social Security Act, including reduced expenditures that may result from--CommentsClose CommentsPermalink





(A) reducing preventable hospital admissions;CommentsClose CommentsPermalink





(B) more appropriate use of pharmaceuticals; andCommentsClose CommentsPermalink





(C) reducing duplicate or unnecessary tests.CommentsClose CommentsPermalink





(b) Report- Not later than 3 years after the date of enactment of this Act, the entity conducting the study under subsection (a) shall submit to Congress and the Secretary of Health and Human Services a report on the study, together with recommendations for such legislation or administrative action as such entity determines appropriate.CommentsClose CommentsPermalink





(c) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink

SEC. 7. STUDY AND REPORT ON BEST PRACTICES FOR MEDICARE CHRONIC CARE COORDINATION.

(a) Study- The Secretary of Health and Human Services, in consultation with the Medicare Payment Advisory Commission, shall conduct a study of the following issues:CommentsClose CommentsPermalink





(1) The effectiveness of pay-for-performance programs to serve Medicare beneficiaries with multiple chronic conditions, including dementia.CommentsClose CommentsPermalink





(2) The cost-effectiveness of chronic care coordination under the Medicare program.CommentsClose CommentsPermalink





(3) Whether the quality measures used for making payments under part B of the Medicare program, including the measures developed under subsection (k) of section 1848 of the Social Security Act (as added by section 101 of division B of the Tax Relief and Health Care Act of 2006, Public Law 109-432), improve the quality of care provided to Medicare beneficiaries with multiple chronic illnesses, including dementia.CommentsClose CommentsPermalink





(b) Report- Not later than 3 years after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under subsection (a) that contains--CommentsClose CommentsPermalink





(1) recommendations on the best quality indicators for monitoring the chronic care coordination of the conditions of Medicare beneficiaries with multiple chronic conditions, including dementia; andCommentsClose CommentsPermalink





(2) such other recommendations for legislation or administrative action as the Secretary determines appropriate.CommentsClose CommentsPermalink

SEC. 8. RULE OF CONSTRUCTION.

Nothing in this Act, or in the amendments made by this Act, shall be construed as requiring an individual to receive a geriatric assessment (as defined in section 1861(ccc)(1) of the Social Security Act, as added by section 3(b)) or chronic care coordination services (as defined in section 1861(eee)(1) of such Act, as added by section 4(b)).CommentsClose CommentsPermalink